Patients undergoing radical cystectomy for bladder cancer often experience significant lifestyle changes due to postoperative urinary diversion. Those with ureterocutaneostomy or ileal conduit require a urostomy, while patients with a neobladder typically do not feel the urge to void.
In recent years, robot-assisted radical cystectomy (RARC) has been increasingly adopted as an alternative to open radical cystectomy (ORC). This study aimed to evaluate postoperative quality of life (QOL) using the Short Form-8 (SF-8) in patients undergoing ORC and RARC.

We retrospectively analyzed patients who underwent radical cystectomy at our institution between 2010 and 2023. Clinical data including urinary diversion type, patient background, and perioperative outcomes were reviewed. The SF-8 was administered preoperatively and at 3, 6, and 12 months postoperatively.
Descriptive statistics were presented as median and interquartile range or mean and standard deviation. Group comparisons were performed using the Mann-Whitney U test or chi-square test, as appropriate. A p-value of <0.05 was considered statistically significant. All analyses were conducted using EZR, a modified version of R Commander.

A total of 92 patients were included: 31 underwent ORC and 61 underwent RARC.
Regarding patient characteristics and perioperative outcomes, the RARC group had a higher proportion of patients who received neoadjuvant chemotherapy (p = 0.032), significantly less estimated blood loss (p < 0.001), and fewer blood transfusions (p < 0.001) compared to the ORC group.
There were no significant preoperative differences in SF-8 scores between the groups. At 3 months postoperatively, both groups showed decreased scores in physical functioning (PF), role physical (RP), social functioning (SF), role emotional (RE), and the physical component summary (PCS), but the differences between groups were not significant.
However, a significant postoperative decrease in PCS compared to baseline was observed only in the ORC group, not in the RARC group. The decline in the mental component summary (MCS) was also less pronounced in the RARC group, although the difference was not statistically significant (Fig. 1).
When comparing SF-8 changes across urinary diversion types, a significant difference in PF was observed at 6 months postoperatively, but not at other time points.

Despite more patients receiving neoadjuvant chemotherapy in the RARC group, surgical outcomes such as blood loss and transfusion requirements were more favorable. The greater decline in PCS in the ORC group at 3 months suggests that the invasiveness of ORC may contribute to lower physical QOL during early recovery. No significant QOL differences were found among urinary diversion types.
Given the limited sample size, further studies with larger cohorts are warranted.

Robot-assisted radical cystectomy appears to be less invasive than the open approach and may lead to faster physical recovery and less decline in QOL. Further studies with larger sample sizes and longer follow-up periods are necessary to confirm these findings.